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Ethics_4D_L1_Quiz1

 

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1)
The primary goal of this lesson is to teach the ethical ways of dealing with HMO billing problems.
 
True False
 
2)
Choose the best answer below.
 
The new health care movement is just a new version of SOCIAL SERVICES.
Providers can no longer deliver treatment ‘at will’. We must play a form of ‘Mother May I?’ with the insurance company who is paying for the treatment.
This process is called ‘CARE MANAGEMENT’. It’s the AUTHORIZATION process, and it restricts WHO can get WHAT treatment, and for HOW LONG.
These new restrictions on treatment oftentimes conflict sharply with health care professionals’ ETHICAL BELIEFS about what their clients actually need.
All except the FIRST answer above.
 
3)
Which of the statements below IS NOT TRUE, according to this lesson? (choose one)
 
The DOCUMENTATION requirements may in fact collide with the provider’s historical ethics or personal beliefs about what is ‘appropriate’ to write in a client’s chart.
Managed Care companies are purchasing 'problem and disease management' - not 'strengths identification' (although we utilize strengths of our clients in everything we do).
When the Managed Care company denies a request for treatment, they are ordering you to NOT deliver the treatment.
Standardized Level of Care protocols . . . are believed by many to result in questionable clinical outcomes for chemically dependent consumers – and may therefore be labeled 'unethical'.
A provider is always free to deliver any service to a patient according to the provider’s own professional judgment or organizational philosophy.
 
4)
Within the new health care environment, which statement IS NOT TRUE, according to this lesson?
 
When the health insurance company looks at treatment records, they will be taking a VERY close look at whether providers have ACCURATELY reflected the seriousness of the consumer’s condition.
The new expectations for documentation are more in line with traditional PROFESSIONAL ETHICS than we first thought!
If a professional feels that it is UNETHICAL to document the client's weaknesses, problems, and diagnosis, the insurance company won't object.
 
5)
A key ethical issue is this: The insurance carrier – not the provider – decides which treatment _________________
 
will best motivate the client to stay in treatment.
is affordable.
is Medically Necessary.
is consistent with traditional service models.
 
6)
The new expectations for documenting treatment may violate _________________
 
our contract with our employer.
our State licensure regulations and ethical requirements.
our HISTORICAL beliefs about what we should place in a client's treatment record.
 
7)
Health insurance companies make treatment decisions based upon
 
the client's past HISTORY and his DIAGNOSIS
whether the individual is expected to BENEFIT from the treatment
how the client has RESPONDED and COOPERATED thus far
All of the above
Only the first and second options above
 
8)
Current mental health and addiction treatment philosophy AGREES that mental illness and addiction are _________________ However, it is difficult for many people to DOCUMENT in treatment records from this perspective, because they were trained to NOT focus upon problems and weaknesses.
 
a SOCIALLY LEARNED PROBLEM.
INCURABLE.
a DISEASE PROCESS.
TEMPORARY.
 
9)
When providing treatment paid for by MANAGED CARE, which item below is NOT TRUE, according to this lesson?
 
The type of DOCUMENTATION which we place in a client’s treatment record MUST support the AUTHORIZATION which we have received, if we agree to accept the authorization.
Providing the details of why the client needs treatment may seem UNETHICAL to some providers.
Providers don't have to document the FUNCTIONALITY of the client in the treatment record, if they feel that it's UNETHICAL.
Approval to deliver treatment depends upon whether or not the managed care company/administrator agrees that treatment is MEDICALLY NECESSARY.
One key ethical issue, for some providers, is that the insurance carrier – not the provider – decides which treatment will be delivered.
 
10)
In this lesson, which was not said?
 
Working in Managed Care may require revisiting our traditional ETHICS in several areas.
If you have trouble with the ETHICS of spelling out the client’s DYSFUNCTION in clear terms, you will have trouble obtaining authorization for services.
We need a good understanding about WHY the companies who are paying the bills ‘do what they do’.
Accomodating the insurance company may result in LOSING YOUR LICENSE.
We need to understand what the health insurance contractor means by ‘. . . a NEED FOR MEDICALLY NECESSARY TREATMENT’.
 
11)
When documenting the NEED FOR TREATMENT in an insurance client's treatment record, entering the DIAGNOSIS is sufficient to justify the treatment.
 
True False
 
12)
This lesson tells us that 'stepping a client down to a lower level of care' is unethical.
 
True False
 

 

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